How our understanding of ADHD and mental health issues in youth and young adults is changing. T. Sigi Hale, Ph.D.

Transcription

1 How our understanding of ADHD and mental health issues in youth and young adults is changing. T. Sigi Hale, Ph.D.

2 A Neuroscientist s Perspective... Philosophical Theoretical Conceptual A Psychiatrist s Perspective... Practical Solutions Treatment

3 The focus of modern psychiatric work has changed and with this, the nature of psychiatric research has also changed.

4 In times past, the field was mainly focused on Qualitatively Defined Brain Disorders Brain problems that produced clear categorical departures from normal human behavior & experience. Schizophrenia, severe psychoses, brain damage

5 Flat Tire Effects I m having a steering problem I can t understand language Relatively clear relationship between problems and mechanisms

6 However, modern psychiatry has shifted it s focus toward Quantitatively or Dimensionally Defined Brain Disorders * Problems that involve out of bounds expression of otherwise normal cognitive and behavioral abilities. Anxiety Mania Depression DISTRACTION Aggression Lying Defiant Frequency Severity Disruption

7 POOR TUNING EFFECTS NEW CHALLENGES

8 In order to understand a brain that is out of tune, but otherwise intact we can t just think about how the brain breaks we also have to think about how it normally works. This is a more complex challenge that necessarily involves dealing with the whole brain.

9 We have to figure out how to define diagnostic boundaries. Where do we draw the line for ADHD? Neuro-Psychiatric Cultural Philosophical Dilemma???? Continuum of normal attention ability Focused Medication Distracted

10 How much mental/emotional adversity is normal? When is medical intervention warranted? How do we distinguish between suffering caused by brain problems versus societal/environmental circumstances that may be particularly rough for certain individuals?

11 FOR EXAMPLE

12 Ancient expectations about learning and attention. Hands on Exploratory Tinkering Visual Problems Perspective Taking Interactive learning... Practical skills assessment.

13 Modern expectations about learning and attention Memorizing Sitting Still Individual How did these changes impact our impression of what is and is not an attention deficit? Failure = Bad Passive Listening Rote Procedure Abstract Skills Assessment

14 Because it is changing Will our understanding of ADHD change, as our manner of learning and working changes?

15 A COUPLE MORE EXAMPLES

16 How will our understanding of ADHD change as the method of learning biology goes from this?

17 To this.

18 Or when the way we learn about DNA goes from this

19 To this Virtual reality program under development in Finland.

20 The clinical picture With dimensionally defined disorders, such as ADHD, I think it is very important that we constantly reflect on where we are setting our diagnostic boundaries. I think this should be an inclusive society-wide discussion. Especially when it involves medicating children We need to be self-critical.

21 The New Era of Psychiatric Research & The Neuroscience Challenge

22 A dimensional brain problem is very different Qualitative Departure From Normal Quantitative Departure From Normal I ve got a handling problem. Flat Tire Effect I ve got a handling problem. Poor Tuning Effect

23 This has challenged/inspired us to consider brain function pathology in new ways. I ve got a handling problem. I ve got an attention problem.

24 So, in this context, how do we get at what s going on with the ADHD brain? We ask, What has to happen in the brain to make us good at complex goaldirected actions? We answer: We don t know. But we have some ideas about what this system should minimally include. Considering this makes it clear that complex task-directed actions rely on the optimized functioning and coordination of multiple distributed brain systems Which together form an emergent neurocognitive network that is specialized for complex task directed actions.

25 Higher-Cognitive (i.e., Executive) Functions Quickly identify taskrelevant sensory items. Organize, maintain, update task-directives Update plan sequence in VWM Translate that information into verbal articulatory codes (i.e., naming). Regulate all the lower-level auto-pilot stuff.

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27 Assuming the sub-cortical horse is well behaved Let s explore the neurocognitive network that allows us to be good... at getting things done. To be a good Task Master

28 you have to be able to quickly identify task-relevant sensory items.

29 A demonstration A task Find the parmesan cheese in the next photo as fast as you can and then raise your hand. Ready

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31 One More But this time Find some tape. Ready

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33 These types of task-directed visual searches represent a very specialized manner of sensory information processing that allows us to quickly identify the things we re looking for. So we can get things done. How does this work?

34 The Task Master Neurocognitive Network LH 1. Go to kitchen 2. In the fridge 3. Second shelf 4. Next to milk on left 5. Get apple 6. Bring to Dad in living room RH APPLE 34

35 The point is To do this task, you barely have to see the apple You want quickly identify the sought after item using the minimal sensory exposure required to do so.

36 Rather than quickly identifying a task-relevant stimuli You want a sensory immersive experience. LH Paint Apple RH 36

37 Sensory Immersive Experience To Discover Visual Problem Solving Task Master Executive Function Mode

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39 The brain changes into different specialized states/modes in order to service different genres of cognitive and behavioral actions. Task Master Mode Creativity Mode Novelty Seeking Mode Sensory Immersion Mode

40 That s the big picture stuff. Now some details

41 A primary goal of task-directed brain function is to align sensory encoding operations with task-objectives. A Task Master Neurocognitive Network VWM Top Down SWM Increased processing of task-extraneous content during task challenges. Linguistic Encoding Regulate Sub-cortical Bottom-up Perceptual Encoding Increased attentional shifting. Visual Sensory Overflow in relation to task objectives Convergent Deficit Effects

42 RH Information Processing Bias in ADHD- A Convergent Deficit Effect Assoc. to standard cogs *RH: intact or superior *LH: impairments Psychophysics *Strategy Based *Abnormal L to R fmri Gene Effects LH RH CPT Beta2 Asymmetry CPT P8-P7 EO P8-P7 EEG p= Estimated Marginal Means Familial Effects 42

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45 The ADHD Battle of the Brain States Require high resolution visually weighted sensory immersive information processing. Sensory Immersion Mode Fluid attention Requires, quick and dirty identification of the stuff we re looking for. Visual Prob. Solving Mode Fight or Flight Mode Task Master Mode VS. Novelty Seeking Mode Fixed attention

46 The Normal Brain Sensory Immersion Mode Task Master Mode Visual Prob. Solving Mode VS. Fight or Flight Mode Novelty Seeking Mode

47 What can we do to help? VWM Top Down SWM Negative Feedback Effects Linguistic Encoding Regulate Sub-cortical Bottom-up Perceptual Encoding Too much off-task information! Visual Sensory Overflow in relation to task objectives Increased attentional shifting (i.e., a flexible attention mode).

48 So turn the sensory faucet down?

49 Better Functioning of Task Master Mode? VWM Top Down SWM Regulate Sub-cortical Linguistic Encoding Bottom-up Perceptual LF-TMS Encoding RH TPJ Visual Sensory Overflow in in relation to task objectives. Increased attentional shifting (i.e., a flexible attention mode).

50 Really Good Pilot Data! Posterior brain function shifted leftward. Attention performance improved! One session

51 The Normal Brain Sensory Immersion Mode Task Master Mode Visual Prob. Solving Mode VS. Fight or Flight Mode Novelty Seeking Mode

52 Circumstances Working Against the Task Master Neurocognitive Network Self-regulation issues Novelty Seeking Adrenaline Junkies Anxiety Depression Systems Coordination Brain State Creative Types Visual Thinkers Modular Deficits Learning Disabilities

53 Assess brain function at the level of ADHD individuals Individual Variability

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55 Relatively Fixed-Modular to Relatively Dynamic Functional Emergent Task-Directed Neurocognitive Network Functional Networks (e.g., FPN, DAN, VAN, DMN) Leverage convergent effects Modular Units Neuronal Assemblages Visual Sensory Overflow Neuronal Molecular Genetic

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57 And, we want to keep in mind

58 Balance Sensory Immersive Experience To Discover Visual Problem Solving Task Master Executive Function Mode

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60 The End